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-~- <br />Certifroadoa: <br />As an authotiudrepresentative ofthe applicant, l hereby certify that the operation descnbed has met the minimum requirements of the <br />following terms and conditions: <br />All necessazy approvals from kx:al govertmamt lave been applied for (Section 3432.5-110(1 xaxVlIl). <br />2. To the best of rtry k>mwledge, all significant, vah~able and permanetttman-made strucnne(s) in exisOem:e at the tithe this <br />application is filed, and located within 200 feet of the proposed affected area have bcett identified in this application <br />(Section 3432.5-] 15(4xe), CRS.). (NOTE: For 110 opetatioas, the affected area ituhrdes all lands delineated by the petmit <br />boundary) <br />3. No mining operation wt71 be located on lands where such opetatiota: ate prohtbired by law (Section 3432.5-115(4xQ, <br />C.R.S.). <br />4. As theapplicam/operator,Ido~thaveaoymimnglexptorationopetatioffiintheStateofColotacboa¢remlyinvio}ationof <br />the provisions ofthe Colorado 1_end Reclamation Act forthe Extraction ofConstntction Materials (Section 34-32.5-120, C.RSJ. <br />5. I undetstattd that statements m the application are being made nnderpeaaltyofperj~ayatd that fake smtemcnLS made herein <br />arc punishable as a Class I rr»sdemeanor putsuain to Section 18-8-503, C.RS. 1984. <br />Tklsform bas brae approved 6yNteMiaed Lend Reclamation Boardparsaaat to secNoa 3h32.5-1I0,CRS, oftheColarado Load <br />Redamaatoa Au jot the Extraction ofConstnrdion Mattslak. My alteration or modlJleaNoa ojthisform shot! recall in vowing <br />say pemr# instead oa the shared or mod{/led form and snLfect the operator m cease sad desist orders sad civil pendlies jot <br />operating tv#botd a perm# parsaaat to seulon 3h325-123, C1P.S <br />Signed and dated this a ~1~ day of (SJ Urp F~1 , ~~. <br />~,,}u G. M~RC7AN ~u c,4 rJ dT i 1aC~ ~ .='X(G. <br />Applicam/Opetator <br />Signed:/ iy~~//"/i~ t <br />Titk: ~~,A //.~ e h f <br />Sinteof l:<:(.o0.t.!'AO 1 <br />ss. <br />County of ~. U.~,p G<k n!< o I <br />The foregoing instrument was acktawledged before roe this eC5 <br />_, by uL ~O G~A-I~ as _ <br />_ F14L ~oaG,4N ~x-ckv~E r.,~.c. .Z~~(~G. <br />fr' ~ ,~''•, n,' <br />~ ,~ i <br />'t i ~ t~ <br />~.!.. .... ~.at~A~ a` <br />If Corporation <br />Signed: ~((t•`S~_~1". <br />Ctnpotate Secretary or <br />Town/City/County Clerk <br />day of dcZol~ Erb.. ~~, <br />RCS ~ ~6 tit T of <br />MyCormtrission expires: ~E /l't86R ~~Vllr7 <br />SIGNATURES MUST BE IN BLUE WK <br />10 (Appmrd Os/I !/zoos) <br />